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Case Series
Endoscopic versus surgical management in Bouveret’s syndrome: A case series
1 General Surgery Resident, General Surgery Department, ULS Alentejo Central, Évora, Portugal
2 General Surgery Consultant, General Surgery Department, ULS Alentejo Central, Évora, Portugal
3 Head of Department of General Surgery, General Surgery Department, ULS Alentejo Central, Évora, Portugal
Address correspondence to:
Joana Simões Bolota
ULS Alentejo Central, Largo do Senhor da Pobreza, 7000-811 Évora,
Portugal
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Article ID: 100129Z06JB2024
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Bolota J, Leandro S, Cotovio M, Cinza M, Senhorinho R, Carvalho M. Endoscopic versus surgical management in Bouveret’s syndrome: A case series. Case Rep Int 2024;13(2):5–10.ABSTRACT
Introduction: Bouveret’s syndrome is a rare entity, accounting for 1–3% of gallstone ileus cases. It is more common in elderly females and is associated with significant morbidity and mortality. It presents with epigastric pain, nausea, and vomiting in patients with concurrent cholelithiasis. Given the nonspecific symptoms, the diagnosis is supported with imaging highlighting Rigler’s triad. The therapeutic approach can be either endoscopic or surgical.
Case Series: The authors present two cases of Bouveret’s syndrome, managed with two different approaches. The first case is an 82-year-old man presenting with diffuse abdominal pain and distension, nausea, and vomiting. Blood tests showed increased inflammatory parameters and an abdominal computed tomography (CT) scan compatible with Bouveret’s syndrome. Upper gastrointestinal (GI) endoscopy revealed a fistula at D2 level, and an obstruction at D3, caused by a 3 cm gallstone. The patient underwent laser and mechanical lithotripsy for gallstone removal. The second case is a 71-year-old woman presenting with vomiting associated with dehydration and abdominal pain for several days. Blood tests showed increased inflammatory parameters and CT scan showed a bilioduodenal fistula at D2 level, with a 5 cm a gallstone at that level, confirmed in the endoscopy. An attempt to remove the gallstone was performed, without success, so the patient underwent laparotomy with extraction of the gallstone via an anterior gastrotomy.
Conclusion: Bouveret’s syndrome is a rare disease that requires thoughtful and tailored management. Given this rarity, there is minimal data to support specific therapy recommendations. Therefore, management should be tailored to the patient at the discretion of the multidisciplinary team and the resources of the institution.
Keywords: Bouveret’s syndrome, Cholecystoduodenal fistula, Cholelithiasis, Endoscopic lithotripsy
SUPPORTING INFORMATION
Acknowledgments
The authors would like to thank Artur Silva, MD and Joana Oliveira, MD for their contributions to this article.
Author ContributionsJoana Simões Bolota - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sofia Leandro - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Manuel Cotovio - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Margarida Cinza - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Rogério Senhorinho - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Manuel Carvalho - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2024 Joana Bolota et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
